The article by Dr Davis and colleagues1 titled, "A 2020 Vision For American Health Care" is indeed a thoughtful plan with much to recommend it, but it seems a bit complicated, offering too wide a target for meddlers to muss up the several basics on which a rational and workable system must rest.

There is a movement pushing a "single-payer" system,2 basically a Medicare extension, that has the advantage of simplicity and presumed (not proven) efficiency but cedes to the single-payer monopoly (in this case the federal government), which is open to political manipulation. Worse, it is based on a fee-for-service compensation system that encourages overutilization. Something in between is needed that borrows the best from managed care (incentives to practice efficiently) plus universal coverage and some degree of both choice and quality control.